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Female genital cutting

Female circumcision, or cutting, is an age-old tradition. Depending on the tradition, a girl or woman may have part or all of her external genitals removed.

It’s a 5.000-year-old tradition whereby a young girl or woman has parts of her genitals cut. FGC is especially practiced in Northern and Eastern Africa. Girls are usually cut between the ages of four and puberty. It can also happen much later or earlier (even a few days after birth).

Depending on the local customs, a girl or woman may have part or all of her external genitals removed.

What is female genital cutting?

There are four different types of FGC, according to the World Health Organisation.

The first type involves the removal of parts of the clit or the entire clitoris. This is called a clitoridectomy. The second type is similar, but additionally, the inner labia are removed. Sometimes the outer labia are also cut off. The second type was – and sometimes still is – practised by, for example, the Kikuyus in Kenya.

With the third type, which is also called ‘infibulation’, all of the clitoris and the inner and outer labia are cut off, and the wound is stitched shut. 

The fourth type is a variation of type three but goes one step further: parts of the vagina may be stitched shut or tightened through chemicals, or is alternatively pierced, burned or scarred. Any additional harmful procedure to the vagina is also type four. This type is seen most among women of Kenya’s North Eastern tribes.

All of the types have slight variations, depending on the local traditions. 

Most of the cut women fall into categories one and two; categories three and four are most common in Eastern Africa. It’s estimated that 15 per cent of all cut women in Africa underwent infibulation (type three).

Reasons for the cut

The reasons behind parents wanting their girls to be cut are mostly cultural. In many cultures in Northern, Eastern, and Western Africa, being cut is a rite of passage for young girls and improves their chances of getting married. It’s thought that FGC will keep a girl a virgin and keep her from sexual activity before marriage. Some also think that it’s more hygienic and that a girl or woman should be flat, rigid and dry.

Religious beliefs also play a role. Some Christian and Muslim communities believe that the cut is related to the teachings of their religions. Although FGC isn’t approved by either Islam nor Christianity, supposed religious laws (e.g. the mention of ‘Sunnah’) are used to rationalise the practice.

One of the myths around FGC makes people believe that the cut will actually enhance a woman’s fertility and promote child survival. Another myth claims that cutting a girl will cure or prevent STDs like gonorrhoea.

It’s also believed that FGC will keep a girl or woman from having sex before marriage and that it increases a man’s pleasure.

The Pokot, for example, believe that a woman’s firstborn child won’t survive unless she’s circumcised. If the mother is not circumcised she won’t have linked herself to the ancestors by getting their blessing through the shedding of blood, and therefore it’s thought the baby has to die. There are also myths that a clitoris will continue to grow until it touches the ground if it isn’t cut. Others think that an uncut woman is too sexual – and that she might get up to cheating when her husband isn’t around.

Circumcision, cutting, or mutilation?

Female circumcision is called different names depending on who’s talking about it. Because of the serious health consequences associated with it and the violation of girls’ and women’s rights, female circumcision is also called female genital mutilation (FGC). Other people have adopted the more neutral term of female genital cutting (FGC) to acknowledge that it’s a procedure, while not giving the false impression that it’s similar to male circumcision.Circumcision, cutting, or mutilation?

At Love Matters, we’re aware of the on-going debate between age-old traditions and human rights. We’re also aware that any form of genital modification – cutting, pricking, burning, or stretching of the female genitalia – can cause serious lifelong health problems.

These health problems can be so severe that we agree that female genital mutilation is an appropriate term for these different procedures. Yet, for the purposes of helping ‘circumcised’ young girls and women (and their partners), we’ve made a conscious decision to use the terms female circumcision and female genital cutting (FGC). Our rationale behind this decision (described below) isn’t to deny the serious health consequences, but to provide helpful information to suffering people without re-traumatising them.

Our rationale

Young girls and women who have been ‘circumcised’ are often not aware of the associated health risks of these procedures. Even if they were, they still often face other difficulties.

In some cultures, baby girls are cut soon after birth. In other cultures, girls and women may have never met someone who hasn’t been cut, so being circumcised is normal, and not the other way around.

Calling someone’s genitals mutilated or abnormal may just reinforce the trauma. 

First of all, a young girl or woman may not have known she was ‘mutilated’, but once she does may feel ashamed of her genitals. Secondly, and more likely, she may be left feeling betrayed by her family, community and/or religion since the procedure is often done without proper consent. Lastly, finding out that she may continue to unnecessarily suffer from FGC’s effects for a lifetime, may just add to the burden.

Contemporary practices

Female circumcision’s origins can be traced back to ancient Egypt. It’s believed to have spread by trade routes from Egypt to West Africa and to Indonesia with the arrival of Islam. Its practice predates Islam, Christianity and Judaism.

Today FGC is most commonly practised in 28 African countries, as well as in parts of Oman, United Arab Emirates, and Yemen. To a much lesser extent, it’s also found in certain communities in India, Indonesia, Malaysia, Pakistan, and Iraq. With the advent of migration from these countries, immigrants have continued this practice in their new home countries: Canada, the US, the Netherlands, Italy, Sweden, the UK, and Australia.

Since only 20 per cent of all Muslims practice female circumcision, it can’t be seen as a strictly Muslim observance. Some Christian and Jewish communities also practice it.

In Kenya, 38 of the 42 tribes are still practising FGC or have done so in the recent past. Most FGC happens among women of Somali descent and those living in Northern and Western Kenya where it’s particularly prevalent among Kisii and Maasai women. Luo and Luhya women are the least likely to be cut.

FGC is usually done by a circumciser within the community, but can also be done by relatives. On occasion, it also happens in hospitals – but such cuttings are rejected by some communities as it’s seen as an impure ritual. In Kenya, close to 80 per cent of all circumcisions are performed by a ‘traditional’ circumciser who has little or no medical training.

The ritual

All cultures have their own rituals when it comes to FGC. But it’s usually accompanied by celebrations, as it’s regarded as a very important point in a girl’s life. The Pokot, for example, sacrifice a tree for the girl who is cut. A very straight tree is chosen, to indicate the straight and special path a girl is to follow in her life. The girls and their mothers also need to shave their heads, as hair is often seen as a sex symbol. Men have their own rituals but usually stay away from the women during this time. Often, FGC is done to many girls at once.

Is FGC the same as male circumcision?

In short: no.

Male circumcision involves removing the foreskin that covers the head of the penis. To be comparable, female circumcision would only remove the clitoral hood. But most types of female circumcisions involve more than this. Complications associated with FGC, which can continue through a lifetime, are also much more severe than those of male circumcision.

Complications

FGC can be dangerous and cause lifelong health and emotional problems for women who have been cut. If the procedure isn’t done in a clean environment with sterilised medical tools, serious infections can result. Such infections can even kill, especially if the infections aren’t tended to.

Once the wounds have healed, other problems may arise. Women who have been cut can have a higher frequency of urinary tract infections, vaginal infections, menstruation problems, pain during sex, and chronic pain. Incontinence, fistulas and cysts are also common. FGC can even result in infertility.

During childbirth, being cut can cause real risks for both baby and mother. With types three and four of FGC, the vagina is often too tight to allow the baby to pass through. A prolonged and obstructed labour can cause all kinds of complications for both mother and baby, with the most severe being death.

Women who have been cut are more likely to get small wounds and tears around their vaginas when they are having sex. Especially with types three and four circumcisions, men have to use more force to enter the vagina which causes pain. Because of these wounds, there is a higher risk of getting infected with STDs such as HIV if no condom is used. Other infections are also common.

Another complication can be a fistula. A fistula is a hole between the vagina and bladder or anus. Fistulas lead to incontinence whereby you can no longer properly control your urine flow or bowel movements. It also comes with other medical and social consequences.

Fistulas are often the result of complications while giving birth to a baby. One cause can be that the baby doesn’t come out easily because the opening of the vagina is too tight, which is often the case with women who have undergone types three or four of female genital cutting. So when women don’t have medical help while giving birth and there are problems, a hole can form between the bladder or anus and the vagina. This hole is called a fistula.

Because the fistulas are holes between the bladder or anus and vagina, women with fistulas are incontinent, which means that they are constantly leaking urine and stool. The accompanying smell makes people think they are unclean. In turn, families may push away their daughters or husbands reject their wives, making the women social outcasts. Fistulas can also cause other medical problems.

Reinfibulation

Often with women with a type three or four cut, their opening is too small for having sex or a baby. So the opening has to be cut open to be big enough for a penis or a baby to pass through. Then, after she has given birth or had sex, the raw edges of the vagina are stitched back shut again. This is called ‘reinfibulation’.

Doing this several times, for example after having several children, can cause thick scarring of the tissue around the vagina, which in turn can cause even more problems and pain. And of course, with such open wounds, the likelihood of infection increases during sex and labour.

Using excessive force during sex to be able to enter the vagina can also cause more tears, wounds, and pain.

FGC and pleasure

Many cut women wonder whether they’ll ever experience the pleasures of sex.

For women who have been stitched shut, it can be hard to enjoy sex. The opening that is left is very small, and often too small for a penis to enter without pain (using lots of lubrication can help with this). Nevertheless, there are women who report having a normal and enjoyable sex life even with this kind of FGC. Sexual pleasure is different for every woman. So some women who have been cut can still experience pleasure.

For women with category one and two FGC, it’s harder to reach orgasm than for women who haven’t been cut since the clitoris is one of the main pleasure centres for women. Many women achieve orgasm most easily by stimulating the clitoris. However, you can still have an orgasm even when you don’t have a visible clitoris. The outer part of the clitoris is only a small part of a much bigger organ, goes deep within the body. With an understanding and patient partner, you should be able to have pleasurable sex – it’s a matter of trying what you like and what makes you feel good.

It seems that women who have been cut before they became sexually active are better able to adjust. Women who are already sexually active when they undergo the procedure have more sexual difficulties, according to studies. Men can also experience difficulties during intercourse with a cut woman. Because the vaginal opening is so small, thrusting can be painful and even cause wounds and infections on the penis. Being gentle and using lube can be helpful.

Generally, women who have been cut aren’t less likely to have sex, though, studies show. Neither do they seem to start having sex later than their uncut counterpart. This research goes against one of the key arguments for FGC: that it keeps women from having more intercourse or having sex earlier.

Reversing the cut

A surgical procedure called ‘defibulation’ or ‘deinfibulation’ reopens the vagina of women with types three or four FGC. It restores the vagina to its normal size, and may also include removing some of the scar tissue and restoring the labia.

With pregnant women, this is usually done around the 20th week. This way, the tissue has time to heal before the baby comes out. Doing this will also decrease the risk of miscarriage.

There are some surgeons who are experimenting with new techniques to restore the clitoris. Tissue from the clitoris still inside the vagina can be used to make a new clitoris on the outside. However, this procedure is still relatively new and not yet widely done.

Women who have undergone this procedure usually feel far less pain during sex, pass urine more easily and have fewer problems during their menstruation. Also, having defibulation done before giving birth greatly reduces the risks for both mother and baby.

FGC in numbers

The World Health Organisation estimates that between 100 and 140 million young girls and women have undergone some form of female circumcision. It’s thought that an additional two to three million female circumcisions still take place every year. But because the ritual is often performed in secret or is even illegal, collecting information on FGC and estimating how often it is actually performed is very difficult.

In Kenya, it’s estimated that two out of every five women are cut. It’s thought that in Northern Kenya, there are areas where as many as 98 per cent of the women have undergone FGC. On average, half of the country’s women over age 45 have been cut, while the percentage is lower for younger women. In 2008, it was estimated that 13 per cent of those women cut had undergone infibulation.

Attitudes and law

In 2010, the Kenyan Parliament instated the Prohibition of Female Genital Mutilation Act. Offenders can now be imprisoned for up to seven years or pay a fine as high as KSh 500.000. Before that (since 2001) it was only illegal if done on women under the age of 18.

Attitude shifts are taking place. According to UNICEF in a report from February 2013, numbers are going down. The report also states that men are beginning to speak up to end this age-old tradition, claiming that they won’t mind marrying uncut girls and alternative rites of passage should be found. For some men, FGC also comes with additional costs: it’s not unheard of that men have to sell their livestock to pay for C-sections and emergency surgery when their wives suffer the consequences of FGC during labour.

Because most girls are married off immediately after the procedure and have to drop out of school while they are essentially still children, FGC is often associated with a lack of education for girls and women and criticised for this.

Of the Kenyan women who have been cut, almost 60 per cent believe that they gained nothing from the cut, 24 per cent thought it gained them social acceptance and 15 per cent said it helped them remain a virgin. On the other hand, 90 per cent of the uncut women said FGC had no benefits at all. With the exception of women in the North Eastern province, the overwhelming majority of Kenyan women think that the practice should stop.